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It’s must reading. For those of you who don’t know Krauthammer is a MD, who trained at the Massachusetts General Hospital back in the 1970s. Specifically he’s a psychiatrist and saw a lot of a patients like the Navy Yard shooters.

My experience reflects his and the situation has only gotten worse since his active practice days.

I had a lot of homeless patients in my career and while some of them were the stereotypical drunks that the general public thinks of, many of them had serious psychological problems for which they received no treatment.

When the state run mental health hospitals started to close in the 1960s, they were supposed to be based by “community based” out patient facilities that would take the place of the restrictive in patient facilities that were expensive to operate. For the most part that never happened. Plus laws were passed giving the mentally ill the right to refuse medical treatment unless they were a danger to themselves or others. As a result, unless someone overtly attacked another person or tried to kill themselves, they couldn’t be forcibly treated. Some states have since changed their laws to allow for patients to be treated against their will, but only to the point where they are no longer a danger.

The result is a cycle of treatment, release, bizarre behavior, treatment, release, bizarre behavior.

Many of these mass killers should have been committed to in patient facilities, but weren’t for a variety of reasons.

Instead of a comprehensive review of how we treat mentally ill people in this country, we get calls for more laws restricting access to guns and making it more difficult for law abiding citizens to become gun owners. The politicians know what the real problems are and know that the real solutions are going to require hard work and probably cost significant amounts of money. If there is anything politicians hate, it’s hard work, especially when they are going to be required to do the work. So, they’ll take the easy route and make speeches about evil guns that weren’t used in this crime, tougher background checks, and of course more laws that will place a burden on people who aren’t the problem.

Comments

I was extremely disappointed in the aftermath of the Newtown CT shootings. In his initial address after the school shooting, Obama mentioned (however briefly) that the mental health infrastructure needed to be examined. Not much; but more than any other public figure had done up to that point. Somehow, I probably should have expected, that idea of fixing mental health got lost between the immediate aftermath and when the legislation finally hit the fan in Congress.

As for Krauthammer, he’s partly right. Yes, there is a hesitation among some to order involuntary commitment; but anyone in EMS knows that involuntary commitment is just a band-aid and not the answer. How many frequent fliers are psych patients who go off their meds, get put on a 72 hour hold, get better with the meds with the temporary hold, are released with no follow-up or outpatient resources to assist them, go off their meds…lather, rinse, repeat.

The involuntary holds don’t prevent tragedies like this; they just delay them. Only appropriate follow-up and/or outpatient care will prevent these people from getting to the “powder keg” stage.

The problem is that many states, including mine, require by law that psych patients be treated “in the least restrictive setting possible”. That means that once they are stabilized with medications, they can not be held against their will. Even when outpatient resources exist, patients often just disappear and never follow up. We only find them when they do something outrageous enough to attract the attention of the police. If you can figure out how to get people to show up consistently for outpatient treatment, you’ll be doing something at which no one else has been successful.

Some people need to be locked away, but that requires a judge to order an involuntary commitment. Some of those people will never be well enough to be released, but some will.

It’s a tragic situation and there doesn’t seem to be any real solution in sight.

I will also add the Obama never for one second planned to do anything about mental health. That was lip service to appease some people while he tried to push his real agenda, gun control, through Congress. He’s done nothing since December to address the glaring defects in mental health care and never will.

All About Me

After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it?
I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs.
I still write about EMS, but I'm adding more and more non EMS subject matter.
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